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Review
. 2024 Sep;24(9):423-438.
doi: 10.1007/s11910-024-01361-y. Epub 2024 Jul 29.

Migraine Management in Medically Complex Patients: a Narrative Review

Megan A Hird  1 , Claire H Sandoe  2   3
Affiliations
Review

Migraine Management in Medically Complex Patients: a Narrative Review

Megan A Hird et al. Curr Neurol Neurosci Rep. 2024 Sep.

Abstract

Purpose of review: The current review aims to provide an overview of migraine treatment strategies in medically complex patients, including those with renal, liver, and cardiovascular disease.

Recent findings: In cardiovascular disease, gepants are likely safe for acute therapy; NSAIDs, ergotamines, and triptans are not recommended. Beta-blockers, ACEi/ARBs, and verapamil have potential cardiovascular benefits in addition to migraine preventive benefit. Frovatriptan requires no dose adjustments in kidney disease or in mild to moderate liver disease. Gepants are safe acute and preventive treatment options in mild and moderate renal and hepatic disease. TCAs and valproic acid require no dose adjustments in renal disease. OnabotulinumtoxinA is likely safe in cardiac, renal, and hepatic impairment. Although CGRP monoclonal antibodies are likely safe in renal and hepatic disease, further study is needed in these conditions as well as in cardiac disease, and no dosing recommendations are available. Effective options are available for those with complex medical comorbidities. Further research is required on the safety of newer migraine-specific therapies in these complex populations.

Keywords: Cardiovascular disease; Liver disease; Medically complex patients; Migraine; Renal disease.

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